Hakan İmamoğlu

Endothelial Nitric Oxide Synthase Gene Expression Is Associated with Hypertension in Autosomal Dominant Polycystic Kidney Disease

Background/Aims: Early occurrence of hypertension is the prominent feature of autosomal dominant polycystic kidney disease (ADPKD). The role of angiotensin-converting enzyme (ACE) gene polymorphism and endothelial nitric oxide synthase (eNOS) gene polymorphism in the clinical course of ADPKD is not well understood. However, data about the expression of these genes are lacking. Thus, we aimed to investigate the polymorphisms and expressions of both the ACE and eNOS genes that affect hypertension in ADPKD. Methods: Whole blood samples were obtained from all participants. ACE and eNOS gene polymorphisms and their expressions were analyzed in 78 ADPKD patients and 30 controls. Gene expressions were assessed by quantitative real-time PCR. Twenty-four-hour blood pressure monitoring was performed for the diagnosis of hypertension in all study participants. Results:eNOS expression and the estimated glomerular filtration rate were found to be significantly higher in ADPKD patients without hypertension than in those with hypertension. Each unit of increase in eNOS expression led to a 0.88-fold decrease (95% CI: 0.80-0.96) in the risk of hypertension in multiple logistic regression analysis. Conclusions:eNOS gene expression is independently predictive of hypertension in the ADPKD population. This study showed, for the first time, a novel link between eNOS gene expression and hypertension in ADPKD.

Preferences of referring physicians regarding the role of radiologists as direct communicators of test results.

PURPOSE Currently, there is a growing need for patient-centered radiology in which radiologists communicate with patients directly. The aim of this study is to investigate the preferences of referring physicians (RPs) regarding direct communication between radiologists and patients. METHODS This study was conducted in a single academic hospital using a survey form. The survey items investigated the preferences of RPs regarding: 1. who should be the communicator of test results when a patient with abnormal findings requests information (the options were the radiologist; another health professional with communication skills training (CST); and the RP with CST); and 2. how the communication activity should be conducted if the radiologist is obliged (or chooses) to communicate with the patient directly (the options were that the disclosure should be limited to the findings in the radiology report; the radiologist should emphasize that the RP is the primary physician; and the communication activity should be conducted in accordance with guidelines established by consensus). The respondents were 101 RPs from various fields of specialty; they were asked to rate the items using a 5-point Likert scale. The effects of age, sex, field of specialty (surgical vs. nonsurgical), and total years of experience as a medical specialist on the ratings were statistically compared. RESULTS Most RPs preferred that the radiologist transmit the information to the RP without communicating directly with the patient (89.1%). Although 69.3% of the RPs declared that health professionals with CST have priority in communication, 86.1% declared that the RP should be the person who received CST. If the radiologist communicates with patients directly, the RPs favored that 1. the disclosure should be limited to the findings in the radiology report (95%); 2. the communication activity should include an emphasis on the RP as the patients primary agent (84.1%); and 3. communication should be conducted in accordance with guidelines established by consensus (73.2%). The percentage of strong opinions did not change significantly with regard to age, sex, field of specialty, or total years of experience, except that surgeons expressed strong disagreement with delegating the communication activity to another health professional who received CST (χ² = 9.9; P = 0.042). CONCLUSION These findings may serve as a basis to implement institutional and national policies for patient-centered radiology.

CT Assessment of Bone Remodeling in the Otic Capsule in Chronic Renal Failure: Association With Hearing Loss

OBJECTIVE Hearing loss (HL) is common in patients with chronic renal failure (CRF), but its cause is controversial. The aim of this study was to determine the effect of CRF on the bone density of the otic capsule using densitometric measurements with MDCT and to evaluate the relationship between changes in the otic capsule density and HL in patients with CRF. MATERIALS AND METHODS The study included 34 patients with nonsyndromic CRF undergoing hemodialysis and 35 healthy control subjects. A CT was obtained, for a variety of reasons, in control subjects who did not have CRF or HL, but patients with trauma and infection were excluded. Control subjects were chosen on the basis of a normal CT and pure tone audiometry findings. Densitometric measurements were made using CT in the region anterior to the oval window and anterior to the internal auditory canal. These measurements were compared between patients and control subjects. Pure tone audiometry was performed to detect HL. The average levels of parathyroid hormone in the previous 6 months and the duration of hemodialysis in patients were documented. The association between the levels of parathyroid hormone, the duration of hemodialysis, and the region-of-interest density values in the patient groups were evaluated using the Pearson correlation coefficient. RESULTS HL was found in 40 of 68 ears (58.8%) in the patient group. A significant difference in the otic capsule density was found between the ears with and without HL. There was a strong negative correlation between the parathyroid hormone level and the densitometric measurement of the otic capsule. CONCLUSION There is osseous remodeling of the otic capsule in CRF with loss of bone density, and this is associated with HL in CRF.

Long-term effect of systemic isotretinoin on female fertility

Abstract Background/objective: Acne vulgaris is one of the most common diseases of the youth. Systemic isotretinoin is the only drug which acts on all of the etiopathogenic mechanisms of acne. Isotretinoin has some well-known side effects. Besides these, there is a suspicion whether it affects fertility or not. Previously, we conducted a study about isotretinoin’s effect on ovarian reserve which showed deteriorative reserve. In this study, we aimed to evaluate the long-term effects of systemic isotretinoin on female fertility. Materials and methods: Of the 82 female patients who were enrolled in the first study, 79 patients were included in this study. Twelve months after the end of systemic isotretinoin treatment, patients were reevaluated by using the same parameters which include anti-Mullerian hormone (AMH), ovarian volume (OV), antral follicle count (AFC), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, free testosterone and total testosterone. Results: The changes in the mean AMH, OV and AFC were statistically significant between the sixth and eighteenth months (the end of systemic isotretinoin treatment and 12 months treatment free). The mean AMH, OV and AFC values at the beginning and at the 18th month were statistically similar. Conclusion: The deteriorative effects of systemic isotretinoin treatment on ovarian reserve, which can be accepted as an indicator of female fertility, diminish in time.

Gossypiboma as a rare cause of abdominal mass

Gossypiboma is a reaction to a foreign body/object left accidentally inside a patient as a consequence of surgery. This phenomenon may be overlooked due to its rarity or under-reported due to possible repercussions. We report an intra-abdominal gossypiboma that was misdiagnosed on ultrasound, and discuss its radiological findings.

Unusual Reason of Groin Pain: Pelvic Polycystic Kidney Disease

To the Editor: A 42-year-old woman was admitted to our hospital with the complaints of intermittent groin and low back pain for 6 months. The patient had been under losartan treatment due to hypertension for 2 years. On admission, she was fully oriented and hemodynamically stable. Physical examination revealed a heterogenous mass that was palpable over the left lower abdomen and suprapubic region. The left groin was painful with palpation as well. Laboratory test results showed that the hemoglobin level was 12.5 g/dL, blood urea nitrogen was 24 mg/dL, and creatinine level was 0.9 mg/dL; urine analysis revealed 2 positive red blood cells, negative white blood cells, and no casts. Urine culture test results were negative. Clotting tests were all within the normal range. Abdominal ultrasound showed that the patient had polycystic kidneys without kidney stones and ectasia; however, the left kidney was located in the pelvis. Magnetic resonance imaging revealed multiple renal cysts in the right kidney, absence of the left kidney, and an ectopic kidney with multiple cysts in the true pelvis (Figure 1). Autosomal-dominant polycystic kidney disease (ADPKD) may present with acute or chronic pain. Chronic pain is generally due to enlarged cystic kidneys causing stretching of the capsule or traction of the renal pedicle. Mechanical pain also occurs due to enlarged cysts that resulted in lumbar lordosis and back pain. Paraspinal muscle group hypertrophy has been observed in ADPKD patients with back pain. In fact, groin pain is not a usual complaint in patients with ADPKD in the absence of kidney stones or urinary tract infection. In this case, we presented a patient with groin pain with ADPKD and pelvic left kidney localization to diagnose the disease. There were only 2 cases in the literature with pelvic polycystic kidney disease. In conclusion, we suggest that groin pain—with or without urinary tract infection or kidney stones—should alert the clinician to the possible presence of an ectopic organ in the pelvic area.

An Unusual Case of Laryngeal Paraganglioma in a Patient with Carotid Body Paraganglioma: Multimodality Imaging Findings

Multiple paragangliomas of the head and neck are rare conditions. Carotid paragangliomas are most common multiple paragangliomas. Laryngeal paragangliomas are very rare neuroendocrine tumors and usually are seen as symptomatic solitary lesions. We present multimodality imaging findings of incidentally detected laryngeal paraganglioma in a woman with synchronous carotid body paraganglioma and positive family history. To the best of our knowledge, this is the first case of laryngeal and carotid body paragangliomas in a patient with positive family history. Radiologists should keep in mind that paragangliomas may occur in various locations as multiple tumors.

Localisation of the radial nerve at the spiral groove: A new technique

Summary Background Localisation of the radial nerve (RN) in the spiral groove by previously reported methods has a wide range and is generalised. The objective of this study was to establish a method unique to a patient to accurately localise the nerve. Methods The distance between RN at the midpoint of the spiral groove (D) and the tip of the olecranon (O) was compared with the most distal wrist flexion crease and fingertips on 100 healthy volunteers. The RN was found by ultrasound examination. Results The mean distance from O to D was 16.22 cm (12.5–20.5 ± 1.55), and mean distances from wrist crease (WC) to second, third, fourth and fifth fingertips were 17.79 (14–20 ± 1.28), 18.66 (15–21 ± 1.32), 17.71 (14.5–20.5 ± 1.32) and 15.62 (12.5–20.5 ± 1.34) cm, respectively. With regards to O–D distance, the strongest relationship was obtained for the distance between the fifth fingertip to the WC (r = 0.708, p < 0.001). This relationship was stronger among females than males (p < 0.001). Conclusion The course of the RN can be easily found at the upper arm by this method, which is unique to a patient. The translational potential of this article This study presents a new and individualised approach to accurately predict the location of the RN in the spiral groove. This method is clinically relevant and can be used to guide the surgical explorations or expedite interventional methods.

The association of endothelin-1 levels with renal survival in polycystic kidney disease patients

BackgroundThe prominent features of autosomal dominant polycystic kidney disease (ADPKD) are early development of hypertension, chronic kidney disease and cardiovascular problems. Thus, we aimed to investigate the role of endothelin, a vascular biomarker, in the clinical course of ADPKD, including renal and cardiovascular survival.MethodsIn 138 patients with ADPKD and 28 healthy controls, we measured serum endothelin-1 (ET-1) levels by enzyme-linked immunosorbent assay (ELISA). Endothelium-dependent vasodilatation (flow-mediated dilatation, FMD) and endothelium-independent vasodilatation (nitroglycerin-mediated dilatation, NMD) of the brachial artery were assessed non-invasively with high-resolution ultrasound. Magnetic resonance imaging (MRI) was performed with a 1.5-T system, and total kidney volumes were calculated using mid-slice technique. To determine PKD1 and PKD2 genotype, we performed molecular and genetic tests involving the following steps: DNA isolation, next-generation sequencing (NGS) and data analysis.ResultsEndothelin levels and height-adjusted total kidney volumes (hTKV) significantly increased while the estimated glomerular filtration rate (eGFR) decreased across CKD stages 1–4. Hypertension was more frequent in ADPKD patients with high serum endothelin. At multivariate Cox analysis, endothelin level, PKD1 truncating mutation, hTKV, high-sensitive C reactive protein (hs-CRP) level and the presence of diabetes mellitus were associated with the risk of overall survival. Moreover, endothelin level, PKD1 truncating mutation, hTKV, age and presence of hypertension were associated with the risk of renal survival. Additionally, body mass index (BMI), FMD, PKD1 truncating mutation, endothelin and triglyceride levels were independently associated with hypertension.ConclusionsIncreased serum endothelin levels independently predict hypertension in ADPKD. Serum endothelin levels are also associated with both renal and overall survival in patients with ADPKD.

ACİL KOŞULLARDA ALT EKSTREMİTE ARTER HASTALIĞININ DEĞERLENDİRİLMESİNDE YENİ BİR YAKLAŞIM

Amac: Alt ekstremitenin periferik arter hastaligi tanisi olan hastalarda Doppler US ile anterior ve posterior tibial arter distalindeki dalga formlarina bakarak proksimalde bulunabilecek stenozu ve/veya okluzyonu tahmin etme konusundaki etkinligini degerlendirmek. Gerec ve Yontem: Calisma periferik arteryel hastaligina ait klinik bulgulari olan 131 hastaya ait 261 ekstremite uzerinde gerceklestirildi. Her bir extremitede iki tip Doppler ultrason incelemesi yapildi: 1. Pelvik arterlerden baslayarak anterior ve posterior tibial arterlerin distal kisimlarini icine alan eksiksiz inceleme; ve 2. yalnizca anterior ve posterior tibial arterlerin distal kisimlarini icine alan hizli inceleme. Hizli incelemedeki dalga formlari uc baslik altinda kategorize edildi: 1. Normal trifazik akim; 2. pulsus parvus et tardus (sistolik akselerasyon zamani>200 ms); ve 3. ve onceki kategorilere uymayan arada kalan akim formlari. Dalga formlarinin okluzyon ve/veya ciddi stenozla iliskisini arastirmak icin Pearson ki-kare analizi ve Bonferroni duzeltmeli z testi kullanildi Bulgular: Hizli incelemede pulsus parvus et tardus saptanan hastalarin hepsinde (n=38), arada kalan dalga formlari saptanan hastalarin ise (n=192) %43.2’sinde ciddi stenoz ve/veya okluzyon saptandi. Normal trifazik akim saptanan hastalarin (n=31) hic birinde ciddi stenoz ve/veya okluzyon yoktu. Ciddi stenoz ve/veya okluzyon ile pulsus parvus et tardus ve trifazik dalga formlari arasindaki iliski istatistiksel olarak anlamliydi (p 200 ms); and 3. intermediary forms which do not fit the previous categories. The relation between occlusion or severe stenosis and the waveforms were investigated by Pearson’s Chi-square analysis and Bonferroni correction z test. Results: Rapid examination revealed proximally located severe stenosis and/or occlusion in all (n=38) extremities with pulsus parvus et tardus and 43.2% of extremities with intermediary waveforms (n=192), whereas no severe stenosis and/or occlusion was detected in extremities with a normal triphasic flow (n=31). The relation between stenosis and/or occlusion and parvus et tardus waveform, triphasic flow was significant (p<0.05). Conclusion: Doppler arterial waveforms in distal anterior and posterior tibial arteries can predict proximally located severe stenosis and/or occlusion in patients with arterial disease of lower extremities. Although this approach is solely inadequate in imaging, it may be used in implementing a fast algorithm in emergency setting Keywords: Peripheral artery disease; Doppler ultrasonography; Pulsus parvus et tardus